Nov 16, 2017

My Father with Alzheimer's Stares at Us and it Feels Creepy

Think of your father as being swept away by currents of memories that cause him to appear as if he is staring at you, but he may instead be reliving powerful memories.

Why do Alzheimer's patients stare so much, why do they look at us vacantly.
By Rita Jablonski
Alzheimer's Reading Room

Our friends at Alzheimer's Team shared this question from a reader with us; and, asked if we could supply some insight.
“Don't know who else to ask. My father with Alzheimer's has recently started staring at me or my wife. Now, I understand what his brain is going through. Or what he might be thinking. But is there any way to make it less Creepy ? Or any info I might not know that can help me understand better, to make it "Less" Creepy ? Thanks.”

Our expert Dr. Rita Jablonski agreed to tackle this question.

There can be a couple of things going on here.

First, the staring may be linked to something physically going on in the brain.

Just like a car manufacturer has models (for example, Ford makes trucks, like F150s, and sports cars, like Mustangs), Alzheimer’s Disease has some variations. One variation involves a faster shrinkage of the parts of the brain that gives meaning to what we see; this part of the brain is in the back of the head.

In order for us to understand what we are seeing, the eyes send signals to the back of the brain, also called the occipital lobe, and the nerve cells identify the object and relate the information to other parts of the brain.

When I worked as a trauma nurse decades ago, I took care of a young man who was shot in the back of the head and lived. He became blind, even though his eyes worked fine.

Without the part of the brain to interpret what the eyeballs were sending, he could not PERCEIVE anything. His vision worked just fine; his perception abilities were gone.

Something similar may be happening to your father. He is gazing (or staring) at you and your wife, but may be having a lot of trouble perceiving you. He is waiting for his brain to tell him exactly what (or who) he is looking upon.

This “variation” has a name, posterior cortical degeneration. In some people, problems with vision occur first. These people may see several vision specialists and even have cataract surgery, but the problems are not with the eyeballs or the optic nerves. The problems involve the part of the brain that gives meaning to signals sent from the optic nerves.

Other weird things happen too, like finding it easier to look at objects that are far away instead of looking at objects close up.

Eventually, memory problems start to appear and a neurologist makes the diagnosis. I don’t know if this is your father’s situation, but if his brain is shrinking faster around the areas responsible for vision, it may explain the staring.

Another explanation involves memory and triggers.

We have all called friends (or children) by the wrong name. My daughter, Sara, bears an uncanny resemblance to my younger sister, Anne. In fact, when we are together as a family most people think Sara is Anne’s daughter!

There are times when I glance at Sara and for a split second, I’m jolted back in time to our home in Philly in the 1980s, as multiple memories are triggered by the way Sara tilts her head or rolls her eyes in typical sarcAnne-asm fashion.

The same thing happens to people with Alzheimer’s Disease but the jarring effect is much greater because a lot of the memories that provide context may be lost or slow to retrieval.

When I’m jolted back in time, I have enough current memories to anchor me in the here-and-now, and pull me back from my reverie.

I have enough concentration power to keep me “tied to the dock” of the present, so that I can drift away a little and savor the moment; I am pulled back to “here and now” and return to the papers I’m grading or the manuscript I’m editing.

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People with Alzheimer’s Disease are like boats with no anchor and no ties to a dock. Without the anchoring effect from a supply of current memories, without concentration abilities to keep them tied to the here-and-now dock, they are sucked into the strong currents exerted by past (and sometimes mixed up) memories of the past.

People with dementia lose their memories in reverse order. Recent memories are lost first, followed by older memories. They are literally moving back in time. I see this all of the time in the clinic, especially when I ask them to tell me what year it is. Women often tell me their maiden name instead of their married ones.

Think of your father as being swept away by currents of memories that cause him to appear as if he is staring at you, but he may instead be reliving powerful memories. Or he may be staring at you and your wife while trying to get his “bearings.”

If your father is moving back in time, he may be wondering who these two people are who are standing in front of him. Did your father grow up with brothers or male cousins? He may be staring at you, wondering if you are his brother, and feeling confused because he may know that his brother died decades ago. Or he may be staring at your wife, wondering where his own spouse is right now.

I hope these explanations prove helpful and remove the “creepy” factor. 

We are often frightened and unnerved by what we don’t understand. Alzheimer’s Disease has a way of doing that to families because much of it defies our definitions of reason!

But when we enter Alzheimer’s World, and we meet our family members within their reality, things start to have their own type of logic.

Rita Jablonski, PhD CRNP is an internationally recognized expert in dementia behaviors. She is tenured professor at the University of Alabama at Birmingham and a funded researcher, with over 50 publications and book chapters to her credit. She is a nurse practitioner in a Memory Disorders Clinic, where she helps people with dementia and their care partners. She shares her wisdom on her blog, Make Dementia Your B*tch.

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